Joint attention for children with autism

ByLondon Speech and Feeding
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Kids Speech Therapist London

Why is joint engagement important for communication development?

It has been well-documented that the development of joint attention is impaired in children who have social communication difficulties or autism. It is, in fact, this impairment which distinguishes children with ASD from children who have other developmental delays.

A lack of joint attention in very young children is an early sign of autism as it is a signal that there is a disruption in the motivation to connect socially with others. Since this is a crucial element, I thought I would outline what we mean by Joint Attention as supported by the research undertaken at Hanen.org.

In typically developing children, the ability to shift attention between a person and an object for the purposes of connecting socially or for requesting develops around the same time. However, for children with ASD, these components emerge one at a time and in a linear fashion. Children with ASD usually start with requesting something and later they may learn to share attention for social sharing. (see pattern below as a general guide).

As with typical development, there is variation in the order that these skills emerge but the following patterns of development is commonly seen:

  • Reaching, taking adult’s arm/hand or pointing to ask for something — but without looking at the adult
  • Gradually alternating looking between person and object of desire
  • Then learning to follow the point of another — which is responding to joint attention initiated by another
  • Directing attention to share interests — without looking at the adult: pointing to a truck on the road/ helicopter circling above
  • Then directing attention to share interest by alternating gaze shift between person and object — here the child is now initiating joint attention.

What is important to note is that in order to fulfil the criteria for true joint attention, the purpose of directing the attention of another person must be social in nature. In other words, it must not be exclusively to obtain a desirable object or event/action. True Joint Attention is seen verbally or non-verbally; we want to share a thought with another person and direct them to something we are interested or excited or spooked by.

For example: we can see an amazing firework display in the distance and we want to quickly direct our friend’s attention to this. In order to do this we might be tugging their sleeve/arm whilst pointing to the display in the distance, and perhaps we might add “wow look over there!” We are doing so simply to share an interest without obtaining anything, we are just being social with each other. So True Joint Attention is not just looking at what we want to have, then look at the person who can get this for us and then point to the item. We can say that this is the precursor to true joint attention, which is purely social in nature.

Because true joint attention is an essential precursor to typical language development, the absence of joint attention in children with ASD contributes to difficulties with language learning. Beuker, K., Rommelse, N., Donders, R. & Buitelaar, J. (2013).

The Hanen programme for Parent Child Interaction teaches parents of children with Social Communication Difficulties step by step how to enable their children to learn to pay attention to an object and the parent at the same time.

We learn how to enable a child to:

  • engage take turns
  • shift eye gaze between toy and adult
  • copy adult’s actions, gestures and then words
  • play with toys in different, new ways
  • interact and for longer periods of time
  • have fun whilst playing

If you would like to know more about the Hanen programme please get in touch. I look forward to exploring the topic with you and help guide you forward if this is something your child is struggling with.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Neurodiversity affirming Speech and Language Therapy

    ByLondon Speech and Feeding

    Introduction

    I am a neurodiversity affirming therapist and I love and endorse play-based therapy. I use it alongside a strengths-focused approach in all my sessions. Find out why we should use these transformative therapy methodologies in all our work and play with our children.

    I always have a range of different toys and activities up my sleeve so that when one toy is no longer interesting, that’s fine. ‘Look here’s a new one, how about we try this one?’ When therapy feels like play, children are more likely to be engaged and attentive, which leads to better outcomes.

    By using play as a context for Speech and Language Therapy we can create opportunities for children to use and practise their communication skills in a natural, real-life setting. This helps bridge the gap between the therapy room and everyday life.

    Goals and targets

    What about goals and targets I hear you say? Of course, as Speech and Language Therapists we always have our goals for any particular child. They can be speech goals (we want Bobbi to produce a ‘k’ sound at the end of words) or communication goals (we want Fatima to ask for something by pointing to it rather than grabbing it). And these goals can be achieved where there is a reciprocation and a positive, playful relationship between the adult and the child. That relationship comes through play and fun.

    Play and fun

    Play is how a child interacts and learns. If it’s fun, interesting, exciting or pleasurable then that is where the magic happens. And that is what we need to return to repeatedly and then see if we can fold our targets into the activity as we go.

    As soon as we expect our child to do something and we try and shape their behaviours towards a certain outcome we no longer ‘play’. We are now in teaching mode, where we direct and where we are ‘in charge’. As a neurodiversity affirming therapist, I believe that all play is valid. We must not get into the trap of thinking that only functional play is valid, that there is only one way to play with that car ramp/puzzle/potato head. Our autistic children often need to play in a particular way to navigate their world and we must not try and stop that.

    When we affirm and validate our child’s play and copy their play with enthusiasm and respect then, in my experience, all children regardless where they are on the neurodiversity spectrum will begin to engage with us, copy us, and learn how to communicate effectively about things that matter to them.

    Play-based therapy allows therapists to tailor interventions to each child’s unique interests and abilities. This individualised approach increases the likelihood of success and progress.

    Strengths-Focused Speech Therapy

    Strengths-focused therapy emphasizes a child’s strengths and abilities rather than their deficits. It recognises that every person has unique strengths that can be harnessed to overcome challenges.

    Focusing on strengths helps us build a positive self-image. This is especially important for children with communication disorders, as it can boost their confidence and self-esteem.

    When we encourage children to play in ways that they enjoy and are good at they feel empowered and more in control of their lives and play. This can lead to increased motivation and a sense of ownership over their progress.

    Now, imagine the powerful impact that can be achieved by combining play-based therapy and strengths-focused therapy in speech therapy sessions. This dynamic combination brings out the best of both worlds. It creates a therapeutic environment that is not only effective but also enjoyable for children and their families.

    As Speech Therapists we can use the child’s strengths and interests as a foundation for play-based activities. This personalisation not only makes therapy more engaging but also more effective.

    An example

    Charlie, a 3-year-old with social communication challenges, had a deep interest in anything that spins. We used this strength and interest to create a variety of spinning activities. As he is allowed to engage in his spinners, we can practise lots of speech and language and provide great phrases alongside his interest and activities: Ready steady go! Stop! ‘another one’ ‘the red one’ ‘again again’ ‘I love it’ ‘it’s a spinner’ ‘Charlie loves this toy’ ‘it’s going fast’ ‘it’s so fun’ etc..

    Over time Charlie started to copy some of these word models and then used them to create his own little phrases, such as ‘the blue one again’. When this occurred, we felt like celebrating because it had come naturally and appropriately to the situation without any coercion or direction. That is what communication is about! Well done Charlie!

    Conclusion

    Play-based and strengths-focused speech therapy approaches are powerful tools and by combining these approaches, we create a therapeutic environment that is not only effective but also enjoyable and empowering for our clients.

    Contact me if you would like your child to have neurodiversity affirming speech and language therapy.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    The importance of child-led therapy

    ByLondon Speech and Feeding

    Child-led therapy is essentially what it says, therapy sessions that are directed by your child. You may think how can my child’s Speech and Language Therapist focus on goals if sessions are led by my child.

    Let us explain…

    Your child will be more receptive and motivated to take part in therapy if they have some form of input. E.g., they can choose what toys they want to play with, or how they want to play with the resources available. If sessions are child-centred then they are much more likely to engage and reach their goals, making intervention valuable. They will also be able to regulate their emotions, and use movement to support their need for regulation. E.g., some children like to jump whilst others like to run. As Speech and Language Therapists we need to use what is meaningful to your child to get the most out of intervention. By focusing on child-led therapy, we can build trust, which will allow us, in time, to use new techniques and activities that your child may enjoy. We want children to be themselves, to show their true personality. Therapy is about enhancing their skills in their own individualised way and child-led therapy allows for this.

    This way of working may seem daunting to some, but it doesn’t have to feel this way. Parents often feel if they are prepared then activities may go smoother. It might be the case, but perhaps it doesn’t give your child the opportunity for spontaneity. We’d like to suggest something that may lead to some surprises. Put out an activity that is your child’s favourite and then a completely new activity. Remember these activities don’t have to be complicated. Often, the simpler the better!

    So, no need to plan, just place two activities out and see what happens! Look out for anything which surprises you, which activity did they prefer? Do they have any sensory preferences? The freedom of choice is a wonderful thing to explore. So, just go with the flow!

    The kind of activities that are useful for child-led play can include:

    • Hide and seek
    • Cooking or baking
    • An Exercise ball
    • Small world play
    • Pretend play
    • Musical instruments (you could even have a go at making your own)

    Child-led therapy is a very useful resource. We have it at our fingertips. We don’t need special resources. You just need yourselves and your child! Sometimes, child-led therapy can be tricky to put in place. It sounds easy but is much harder in reality. So, make sure you give it time and reflect on your experiences. Ask yourselves ‘what went well’, and ‘what could be improved’. E.g., perhaps you gave your child time to lead to begin with, but you didn’t give them enough time to think about their options during the activity.

    How can parents become more child-led in the home environment?

    • Pause and use silence. This gives your child the opportunity to lead.
    • It’s perfectly natural to want to talk. Afterall, this is how adults maintain conversations. If you find yourself talking too much, count to ten! This will allow your child time to respond or initiate in the conversation or interaction.
    • Move down to your child’s level. It’s much easier to see what’s going on if you’re at the same height.
    • Videoing you and your child can really help you to see where your strengths lie. You’ll also be able to make minor tweaks to improve your communication during child-led play.

    Contact Sonja for more advice on speech, language and communication during child-led play.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Speech sounds practice at home

    ByLondon Speech and Feeding

    Speech therapists use a variety of tools to help children master specific sounds, and then the students are sent home with some practice sheets to use daily. Parents are able to observe what we do in the session, but I know that back at home three days later they can’t quite remember what it was all about and how to do the practice.

    Here I explain the importance of visual cues, finger shapes, pictures, and semantic prompts (fancy speech therapy term for word clues!). By understanding these tools, you can turn practice time into a fun and engaging experience for both of you.

    Why Visual Cues matter?

    Imagine learning a new language just by listening. It’s tough, right? Young children learning new speech sounds face a similar challenge. Visual cues act like flashcards for their minds, giving them a clear picture of how to position their mouth and tongue.

    • Mirrors: Encourage your child to watch your face (and theirs) in the mirror as you make the sound together. This helps them see the tongue placement and lip movements required.
    • Mouth pictures: Speech therapy sheets often have pictures of mouths making specific sounds. Point to the picture and explain how the tongue and lips look, then have your child try to imitate it.
    • Your face is the best cue! Don’t underestimate the power of your own face. Over-enunciate the sound and let your child observe your mouth movements. Watch this little video clip where I am teaching the /SH/ sound to my little student. You cannot see him but we are both sitting on the floor opposite one another so that he can see me easily.

    Finger fun: making sounds with our hands

    Finger shapes are another powerful tool in my speech therapy arsenal. Think of them as fun reminders of how to position the tongue.

    • ‘Open Wide’ fingers: For sounds like /AH/ and /OH/, hold your fingers wide apart, mimicking an open mouth.
    • ‘Tongue Up’ fingers: For sounds like /T/ and /D/, touch the tip of your thumb to your other fingers, creating a little ‘wall’ like the tongue tip touches the teeth ridge.
    • ‘Snake Tongue’ fingers: For the /S/ sound, wiggle your pinky finger to represent the snake-like tongue tip.
    • In this little video clip I am demonstrating the C-shape moving forward which I had taught my child, showing how the windy sound (/SH/) travels forward with lips open and slightly pursed.

    Bringing sounds to life with pictures

    Pictures serve as visual prompts to connect the sound with a familiar word.

    • Video clip: I am using the WINDY SOUND picture and the FLAT TYRE sound picture to represent /SH/ and /S/ respectively
    • Point and Say: Point to each picture and say the word clearly, emphasising the target sound. Encourage your child to repeat.

    Unlocking sounds with semantic prompts

    Semantic prompts are fancy words for clues that help your child guess the target sound. They can be simple questions or descriptive words.

    • ‘Can you feel the wind whooshing?’ (/SH/)
    • Think of tyre going flat, or a balloon losing air, or a train coming to a slow halt (/S/)

    Practice makes progress, but fun makes it funnier!

    Remember, the key is to keep practice sessions light and engaging. Here are some extra tips:

    • Short and sweet: Stick to short practice times (5-10 minutes) to avoid frustration.
    • Make it a routine: Integrate practice time into your daily routine, like after breakfast or before bedtime.
    • Positive reinforcement: Celebrate your child’s efforts with praise and high fives!
    • Make it multisensory: Incorporate sensory activities like blowing bubbles for /F/ or feeling the wind for /SH/.

    Parents you’re a vital part of your child’s speech development, and together we can make huge progress quickly.

    Please contact me if your child has speech sound difficulties.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Living life with a lisp

    ByLondon Speech and Feeding

    You may be questioning ‘will my child grow out of having a lisp?’ There are so many myths out there that it’s sometimes difficult to find your way out of a complex maze of information.

    The good news: lisps can be successfully treated by a Speech and Language Therapist and the earlier it’s resolved, the better. We know from the evidence base that some children’s lisps will resolve and, as always, it is completely age appropriate to have this speech pattern up until aged 4 ½.

    As with any speech and language targets your child will need to be motivated to practise their newly acquired techniques, at home and in other settings. They will eventually be able to generalise this skill, but it takes lots of practice. So, think carefully about if your child is ready and motivated before commencing Speech and Language Therapy.

    There are essentially two ways in which your child has acquired a lisp. It’s key here to mention that parents have no blame in this.

    1. They’ve mis-learned it and now incorrect production has become a habit
    2. Children have difficulties organising the sounds to make a clear production

    You may be surprised to realise that there are different types of lisps. But all the techniques will be the same.

    1. Interdental lisp

    When your child pushes their tongue too far forward, they will make a /th/ sound instead of /s/ and /z/

    1. Dental lisp

    This is where your child’s tongue pushes against their teeth

    1. Lateral lisp

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    1. Palatal lisp

    Your palate is the roof of your child’s mouth. Sometimes they will touch their palate when making certain sounds (e.g., /s/ and /z/)

    It’s useful for you to know what type of lisp your child has because you can then support them to make the correct production. You’ll be able to talk about where in the mouth their tongue is and where it needs to be to produce a clear sound. Your Speech and Language Therapist will be able to help you with this.

    Top therapy tips for lisps

    1. Awareness is key. Does your child know where their tongue and teeth are (i.e., are they behind their teeth)? Do they notice the air escaping? Use a mirror so that your child can see not only themselves but also you in the mirror.
    2. Repetition! As with most therapeutic intervention, practice makes perfect. So little and often is key!
    3. Make sessions fun, perhaps around your child’s interests or allow them to drink from a straw
    4. Comment on how the sound is produced (e.g., /z/ is like a bee, /s/ is like a snake)
    5. Use tactile cues. Your child’s vocal folds vibrate when they produce a sound like /z/ but not with /s/. You could use the words ‘loud’ and ‘quiet’ to describe this.
    6. Start with a /t/ sound and gradually elongate the sound to an /s/

    Having a lisp may not be problematic for some, but for other children, it can have a significant impact on their emotional wellbeing. Intervening at an early age can prevent this from happening. We always advocate for early intervention!

    Contact Sonja for support on resolving your child’s lisp.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Five ways to increase confidence and reduce frustration in children with speech and language and communication difficulties

    ByLondon Speech and Feeding
    An orange speech bubble with a testimonial

    Your child’s speech, language and communication difficulties may impact their self-esteem. And they may show signs of increased frustration. You want them to be full of confidence, increasing their participation in school and fully engaging with their peers.

    1. Practise active listening

    Speech difficulties can mean that it’s more challenging to understand what your child says. It’s important to show that you’re paying attention, giving them time to express themselves. Focus on what your child says rather than how they are speaking. Remember to maintain eye contact, and actively listen. Active listening and giving time can be trickier than it sounds. I can provide strategies to support your active listening skills.

    2. Give other means and forms of communication

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    3. Praise efforts

    Providing specific praise allows your child to understand what they’ve achieved. E.g., you could praise the way your child listens, or how they take turns, or their resilience (e.g., “I like the way you listened” or “good listening”). Think of different ways you could praise you child during different activities, so you are prepared with phrases that you can use.

    4. Have clear start and end points in activities

    Some children with speech, language and communication needs have difficulties with transitioning from one activity to another. They also have difficulties with changes in routine. This can add to their frustration and changes in behaviour. So, how do you show a clear start and end to an activity? You can have a visual timetable, or you could have ‘start’ and ‘finish’ boxes where you place all the materials in the box labelled ‘start’. And once the activity has finished, you put the items in the box labelled ’finished’. If you need support with transitions, please contact me.

    5. Use visuals

    Visuals can support your child to understand routine and spoken language. Visuals can range from symbols to online images, to photographs, or a combination. Explore which type of visuals work well for your children. Using visuals can be powerful if used correctly. Make the most of the opportunities that visuals can provide for your family.

    Increase confidence and reduce frustration in children with speech and language and communication difficulties today. Please feel free to contact me if you need any support or tips on maximising these opportunities.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Let’s relax about making EYE CONTACT already…

    ByLondon Speech and Feeding

    There’s been a long tradition with teaching staff and with Speech and Language Therapists working in schools that eye contact should be a goal. It is well known that Autistic individuals (whether that be children or adults) mostly avoid eye contact. Whilst it’s part of the way we communicate, it shouldn’t be used as a necessity for an individual who feels that it is uncomfortable. Whilst it does show that you’re listening and showing an interest, it’s not a fair expectation for neurodiverse children.

    Autistic children can find making and maintaining eye contact physically and emotionally uncomfortable as well as unnatural. It adds an extra layer of stress and has been reported to increase distractions rather than reduce them. Children who engage in conversations in their own way (i.e., with reduced eye contact) are not shown to suffer with schooling, work, or social interaction.

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    It very much depends on the situation. If it places more demands on the child and becomes stressful. Then no. There are many strategies we can use which gain eye contact without placing extra demands on the child. We need to be mindful to adapt the environment and not place neurotypical expectations to meet the needs of neurodiverse children.

    How can you encourage eye contact without demand?

    • If you’re using toys, try holding them up to your eye level.
    • You can adjust your position, try sitting face to face during play.
    • Always get down to your child’s level. This might mean that you lay on the floor if your child is positioned in this way.
    • During play, waiting is extremely powerful. Before a key part of the activity, wait and see if your child looks at you. Remember silence is golden!
    • The best way I find is: do something unusual during play. It might be that you spray shaving foam with the lid still on. Or you bring out a wow toy and make it spin/light up or make a noise. A balloon can be good – see video clip. Use the excitement of the activity, and wait to see if you achieve that ‘BINGO’ moment.
    • Create opportunities when there are no toys involved such as during ‘tickles’ or ‘hide and seek’. Autistic children find it difficult to shift their attention between a toy and an adult. So by removing one option, you’re setting them up to succeed.

    Remember, it takes practice and time for you to develop these skills. Try one at a time and experiment, see which works best for your child. If you need speech, language or communication support or advice, I am always here to help.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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